A new study suggests that people who have high cholesterol levels when they are still in their teens or early twenties increase their risk of cardiovascular disease decades later.

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Researchers found that the increased risk of a heart attack, stroke, or other cardiovascular event persisted even in those who reduced their cholesterol to healthful levels by their late thirties.

Scientists at the University of Maryland School of Medicine in Baltimore led the study, and the National Heart, Lung, and Blood Institute funded it.

Experts associate high levels of low-density lipoprotein (LDL), or “bad cholesterol,” in the blood with the buildup of fatty plaques in the walls of arteries, causing cardiovascular disease.

“Damage to the arteries done early in life may be irreversible and appears to be cumulative,” says study leader Dr. Michael Domanski, professor of medicine at Maryland.

“For this reason, doctors may want to consider prescribing lifestyle changes and also medications to lower high LDL cholesterol levels in young adults in order to prevent problems further down the road.”

The scientists analyzed data from the CARDIA (Coronary Artery Risk Development in Young Adults) study. In the mid-1980s, the study recruited around 5,000 asymptomatic individuals aged 18–30 and began tracking them to investigate how various factors would affect their risk of cardiovascular disease (CVD) in later life.

When participants reached the age of 40, researchers followed them for another 16 years, on average. During this time, 275 of them experienced a “CVD event,” including heart attacks, strokes, blood vessel blockages, or death from CVD.

After adjusting for sex, race, and other recognized risk factors for CVD, the authors of the new study found that the longer participants had high LDL levels, the greater their risk of having a CVD event.

Crucially, people exposed to high LDL that started at a younger age resulted in a more significant increase in CVD risk than people who had accumulated the same amount of exposure at an older age.

“We found having an elevated LDL cholesterol level at a young age raises the risk of developing heart disease, and the elevated risk persists even in those who were able to later lower their LDL cholesterol levels.”

– Michael Domanski

The research is available in the Journal of the American College of Cardiology.

Doctors disagree on how aggressively to treat young patients with lipid-lowering drugs such as statins and lifestyle interventions that reduce elevated LDL levels.

However, the authors believe their work adds to evidence that doctors should intervene as early as possible to reduce a young person’s risk of developing CVD in middle age.

“This underscores the importance of regular cholesterol screenings beginning in early adulthood to help reduce this time of high exposure,” says study co-author Charles Hong, MD, Ph.D., also a professor in medicine at Maryland.

The National Heart, Lung, and Blood Institute advise that doctors screen teenagers and young adults for high cholesterol every 5 years.

The American College of Cardiology recommend that doctors prescribe lifestyle interventions — such as taking exercise, maintaining a healthy body weight, and eating a diet low in saturated fat — to lower high LDL levels in teenagers.

Its guidelines say doctors should consider prescribing lipid-lowering drugs to people between 20 and 39 years of age who have elevated cholesterol levels, especially if they have a family history of early-onset heart disease.

“Cardiovascular disease remains the biggest killer in the world, and this new finding provides a potential way to save many lives,” says Dr. E. Albert Reece, Ph.D., MBA, John Z. and Akiko K. Bowers Distinguished Professor and Dean of the University of Maryland School of Medicine, who was not involved in the research.

“The medical community should sit up, take notice, and respond to this important new evidence.”